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IV Bag Shortages
One of the great ironies is that while health authorities have called for curtailment of manufacturing by the compounding pharmacies, pharmaceutical companies have not been able to meet the drug and medical supply requirements of hospitals and clinics. In 2012, oncologists were unable to acquire sufficient chemotherapy drugs; manufacturers claimed that there was an overwhelming need for the drugs. Since 2010, vitamin injectables and some mineral injectables have no longer been manufactured by pharmaceutical companies; compounding pharmacies have largely taken on the job of manufacturing injectables. IV solution bags are a "staple commodity" for hospital care and have always been available in quantity. However, in 2012, Braun initiated steps to simplify the manufacturing of its IV bags and bottles after years of exemplary production. Braun decided to discontinue providing IV solutions in glass bottles. This was not much of a concern for hospitals and clinics; hospital IV setups were definitely geared for IV bags rather than bottles. However, integrative clinics and chelation centers have long favored IV bottles to avoid injectable drug and nutrient exposure to plastic or plastic-like materials. Braun's IV bags claim to be nonplastic. The other two manufacturers, Baxter and Hospira, do not disclaim that their bags are made of plastic. Early in 2013 Braun began to experience manufacturing problems due to equipment failure and was unable to meet the high demand for its IV bags. Baxter and Hospira both stepped in to meet the enormously growing need.
However, in 2014, the situation for Braun changed from providing limited quantities of IV bags to not providing any IV bags. Baxter and Hospira were able to provide limited supplies for the critical shortage but only for a short period. By mid-February 2014, Baxter and Hospira were rationing shipments of IV bags only to hospitals. While the original shortage was for 1000 ml bags of normal saline, the shortage extended to all IV solutions, including 0.9% saline, 0.45% saline, 5% dextrose, and Lactate Ringer's solutions. As of April 2014, it was impossible to purchase any form of IV solution. Hospitals and clinics are improvising by treating dehydration using one IV bag of solution for 72 hours instead of the typical 24-hour drip. In addition, patients are being switched from IV hydration to oral hydration. Critical situations treated in the OR and ICU are also cutting back on IV hydration. It is clear that hospitals are trying to make do by limiting their IV solutions, but at what point will they run out and face tragedy? For the chelation clinic, however, IV bags are required and are completely unavailable – will these clinics be forced to shut down operations?
What is the cause of this IV bag fiasco? Officially, Braun admits that it is planning a major change in its IV bag manufacturing. However, this does not explain why the shortage has shut down not only Braun but also Baxter and Hospira. One source explained to me that Braun had manufacturing problems in 2012. IV bags were found that had been leaking; apparently the bag machinery had a malfunction. Braun ordered a recall of millions of IV bags. Of course, hospitals and clinics still needed bags, so Braun, Baxter, and Hospira were obliged to manufacture millions of IV bags to replace the defective ones. While the FDA and manufacturers blame the high incidence of flu requiring IV hydration this past winter for the inordinate need for IV solutions, it appears that the massive IV bag recall was the culprit. There are some unconfirmed reports that there will be limited IV bag supplies forthcoming in the weeks ahead. However, there are no estimated dates for when the IV manufacturing will return to normal.
In the meantime, in another irony, at least one compounding pharmacy will be manufacturing limited supplies of IV bags for clinic use. The bags will have a very short shelf life and must be refrigerated until use. As expected, the bag price will dramatically increase. As inconvenient as this may seem, the compounding pharmacy is offering to help chelation and IV clinics that will soon face critical shortages. We must ensure that the FDA does not restrict the operations and manufacturing capabilities of the compounding pharmacies.
Jenna Henderson, ND, on Chronic Kidney Disease
Twenty-one years ago, Jenna Henderson developed kidney disease – a rare condition called focal segmental glomerulosclerosis (FSGS). She was only 22 years old at the time and she consulted with numerous specialists in an attempt to prevent kidney failure. However, in three years she was forced to consider initiating dialysis. She had already begun an investigation of natural alternatives long before Google searches were available. After beginning dialysis, she was intent on finding herbals to support her heart, prevent bone loss, and maintain her immunity. She was successful in developing a natural approach to lessen the damage from dialysis. Succeeding in designing a protocol to help herself, she thought that this information would be very helpful to patients suffering from kidney disease and requiring dialysis. Jenna decided to become a naturopathic physician, enrolling at the University of Bridgeport. In the middle of her education she had a successful kidney transplant. Jenna wrote a doctoral thesis on the safety of herbal remedies with transplanted organs. Dr. Henderson has now established a practice that specializes in naturopathic nephrology. She consults with physicians and patients worldwide, having been recognized for knowledge in using natural remedies with kidney patients. Dr. Henderson's website, holistic-kidney.com, offers information and resources.
In this issue, Henderson explores strategies that doctors may use in managing inflammation in kidney disease. She writes that inflammation is hallmarked in kidney disease by proteinuria – and that proteinuria is easily visible to the naked eye as foamy urine. To the degree that there is a greater level of foaminess in the urine, there is more inflammation. While mainstream nephrology offers a myriad of drug agents to calm down inflammation, Henderson prefers to offer natural alternatives, starting with the diet. Fast foods are bad not only because of their high content of sugar and fat but also because of their high phosphate content. In addition fast foods are cooked in hydrogenated oils that tend to increase inflammation. However, Henderson is equally against consuming high levels of uncooked vegetable and nut oils that are high in omega-6 fatty acid content. She also advises against eating nuts that are high in omega-6 fats except for walnuts and macadamia nuts. She encourages the use of fish oil and eating fish that offer a higher ratio of omega-3 fats; she also encourages the use of clear flaxseed oil. The preferred oil for kidney patients, according to Henderson, is a saturated fat such as coconut oil. She cites how coconut oil helps in preserving nephron functioning. She also plugs hemp oil.
Henderson likes the kidney patient to consider a "semivegetarian" diet with rice, beans, and some animal protein. Vegetarians need to watch that they don't experience muscle wasting by diets that excessively avoid protein content. Dr. Henderson offers a reference showing that genetically modified corn contributes to kidney breakdown – a nice comeback for public health authorities enamored with GMO foods. She also offers a reference of how vaccine administration may cause kidney disease to be aggravated – another useful citation for the medical authorities who say that we need to "treat the herd," insisting that everyone be vaccinated.
Sorry, Starbucks lovers – coffee also aggravates kidney inflammation and it's not the caffeine, because green tea helps counter inflammation. The body's physiologic response to proteinuria and inflammation is to have the liver produce more cholesterol – but this shouldn't be the time to order a "statin." Henderson offers a citation showing how berberine may be very useful in this situation to reduce excess cholesterol synthesis. Henderson also touts the value of ginger in improving kidney functioning; I'll need to add that to my list of the great benefits of ginger.
For those of you who did not get a chance to read Dr. Henderson's excellent primer on FSGS in the June 2013 Townsend Letter, the article is available online.1 Henderson provides a succinct description of the pathophysiology of FSGS in the first half of the article and then an insightful review of available medical treatment as well as naturopathic therapies for managing FSGS. I would think that much of her protocol for treating FSGS would also apply to the other nephropathies. In my Letter from the Publisher of June 2013, I stated that Henderson recommends avoiding the use of most herbs in working with transplant patients. In October 2013, we printed a letter from kidney patient and chiropractic physician Steven Hecht, who took me and Dr. Henderson to task for advising that transplant patients should avoid the use of herbs.2 Henderson, who authored her naturopathic school thesis on this topic, responded to Hecht that kidney transplant patients face challenging issues in needing to maintain immunosuppression with drug therapy and that most herbals interfere with the immunosuppression. She did note that green tea would be acceptable. The letter and response by Hecht and Henderson are available on the Townsend Letter website for your review.3
Jonathan Collin, MD
Notes
1. Henderson J. Focal segmental glomerulosclerosis: a naturopathic perspective. Townsend Lett. June 2013. http://www.townsendletter.com/June2013/focal0613.html.
2. Hecht S. Letter: Focal segmental glomerulosclerosis: a naturopathic perspective. Townsend Lett. : October2013. http://www.townsendletter.com/Oct2013/ltrHecht_Henderson1013.html.
3. Ibid.
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